Provider Demographics
NPI:1639336316
Name:CORNERSTONE DENTAL GROUP LLC
Entity Type:Organization
Organization Name:CORNERSTONE DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRUM
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CARTWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-237-3583
Mailing Address - Street 1:1815 UNIVERSITY DR S
Mailing Address - Street 2:SUITE #3
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4900
Mailing Address - Country:US
Mailing Address - Phone:701-237-3583
Mailing Address - Fax:701-237-4159
Practice Address - Street 1:1815 UNIVERSITY DR S
Practice Address - Street 2:SUITE #3
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4900
Practice Address - Country:US
Practice Address - Phone:701-237-3583
Practice Address - Fax:701-237-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty